Health Insurance Basics


Employer-provided health insurance

Employer-provided health insurance plans, also called group plans , are private plans purchased and managed by your employer. Employer-provided plans need to follow the same rules as other private insurance plans and cover the 10 essential benefits.

Because group health insurance covers a large pool of people, it’s generally much more affordable than a comparable individual plan. Typically, group plans have much lower premiums and deductibles.

If you’re eligible for an employer-provided plan, you do not need to purchase additional coverage through the marketplace . Talk to your human resources department for more specific information about your plan.

Short-term health insurance

Short-term health insurance plans provide limited health care coverage for a temporary gap in coverage. However, it’s very important to note that short-term plans do not count as qualifying health coverage, and may not provide you with all the coverage you need.

Short-term health insurance may still be worth it to cover a short coverage gap of one or two months — for example, if you looking for a new job or a new job has a waiting period before your health insurance kicks in. Many large health insurers offer short-term options.

But be aware that short-term health insurance may have limits that regular health insurance does not have, such as caps on annual benefits paid.

Medicare

Medicare is a federal health insurance program for Americans above the age of 65. It provides free or heavily cost-reduced health care to eligible enrollees.

There are four parts to Medicare that cover different health care services:

  • Part A for inpatient (hospital) care, for which most people pay no premiums
  • Part B, for outpatient care, like doctor’s office visits. In 2021, Part B has a monthly premium of $148.50.
  • Part C, which is also called Medicare Advantage, and allows you to buy into private health insurance.
  • Part D, for prescription drug coverage.

If you’re above the age of 65, you can apply for Medicare through healthcare.gov or your state exchange.

Medicaid and the Children’s Health Insurance Program (CHIP)

Medicaid is a federal and state health insurance program for low-income families and individuals. Medicaid has eligibility requirements that are set on a state-by-state basis, but it is primarily designed for those with low incomes and low liquid assets. It is also designed to help families and caretakers of small children in need. You can typically check if you qualify for Medicaid through healthcare.gov or your state exchange.

The Children’s Health Insurance Program (CHIP) is a federal and state program that is similar to Medicaid, but specifically designed to cover children below the age of 18. The program is primarily aimed at children in families who have incomes too high to qualify for Medicaid but too low to afford private health insurance. Like Medicaid, you can typically see if you qualify and apply on Healthcare.gov or your state’s exchange.


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